Improving Outcomes for Children in the Commonwealth of Virginia

Part of a Series

This Insight is a part of the 2016 Health and Human Services Summit Report.

To see the complete report, click here.

In late 2015, four leaders—William Hazel, the Secretary of Health and Human Resources for the Commonwealth of Virginia; Dr. Craig Ramey, a professor at Virginia Tech; and Accenture’s Howard Hendrick and Gary Glickman—began dissecting a simple but critical question. “What,” Glickman recalled, “are we trying to do for kids?”

Secretary Hazel quickly concluded that Virginia could do more to help the next generation of Virginians, especially by investing more heavily and strategically in early childhood programs. The leaders therefore embarked on an effort to create an evidence-based ecosystem that would allow leaders from different organizations to collaborate and conduct rapid-cycle evaluations to understand the short- and long-term impacts of interventions and generate better outcomes.

Along the way, they would have to confront a number of difficult questions. How would they foster cooperation and encourage data sharing among organizations and jurisdictions that were accustomed to operating in silos? How could they create a supportive organizational structure? Would it be possible to engage academics in a research process that moved at a rapid clip and was not necessarily focused on a specific research question? How would they navigate political sensitivities and ideological differences about the appropriate role of government in children’s lives?

“You’re not just building workforce capacity for providers. You’re building parental capacity because by helping children get a really robust intervention, you’re really going to be able to build that capacity at home, so you can see the improved maternal outcomes also improved the outcomes for kids.”
Howard Hendrick
Director, Business Strategy for Human Services, Accenture

Background: The Abecedarian Project

The inspiration for this initiative came in part from a project that had begun a little over 40 years earlier at the University of North Carolina (UNC). Ramey, then a faculty member at UNC, and a team of collaborators, began to unearth insights about how to help children. This resulted in the Abecedarian Project, one of the most famous and “oft-cited” academic studies on early childhood programs. The most important element of the study was a randomized controlled trial that evaluated the progress of a group of infants born between 1972 and 1977 who were “randomly assigned…to either the early educational intervention group or the control group.” These two groups were then later randomly assigned to an “enriched K-2 grade” intervention or to a “control group K-2 grade” group.

The research yielded several important findings and outcomes. First, the children selected were all from single parent households with below-poverty levels of income. The children who received the early childhood intervention treatment experienced a number of short- and long-term benefits, including higher IQ scores, improved reading and math skills, and better job prospects. Second, the mothers of the children who experienced the intervention were more than twice as likely to graduate from high school and attend college. This, as Howard Hendrick, the former Director of the Oklahoma Department of Human Services, explained, demonstrated that early-childhood interventions were an effective two-generation approach. “You’re not just building a future workforce capacity from the children,” he said. “You’re also building parental capacity for the workforce now.” Finally, Ramey was able to work with numerous state and local governments—including Oklahoma’s Human Services Department—to apply the results of his study to improve the quality of early childhood care services essential to enriching the lives of children in need.

Thus, the Abecedarian Project provided not only valuable insights but also a powerful template for how a collaboration between academics and policymakers can help a state scale the Human Services Value Curve.

What is the Human Services Value Curve?

Learn more about the framework being adopted in the Health and Human Services field >

The Prototype: Roanoke

Glickman, Ramey, Hendrick, and Hazel therefore set out to build on the Abecedarian Project’s legacy and establish a collaborative, evidence-driven ecosystem for early childhood development in Virginia. A key part of this would be creating an environment in which stakeholders were comfortable sharing data with one another so that they could employ an analytical tool to determine quickly the impact of different interventions and, in turn, how best to invest resources.

While the leaders eventually hoped to employ this model across the commonwealth, they decided initially to establish a prototype in Roanoke, a city in western Virginia. Roanoke was an attractive testing ground in part because of its proximity to rural areas with high unemployment rates and low educational attainment. In addition, there were a number of stakeholders—including local medical providers, universities, local government officials, and non-profits—that were devoted to helping children and enthusiastic about partnering. Finally, the city’s population (which is just under 100,000) provided a sample size that was large enough to conduct randomized evaluations and tease out causal relationships but still small enough so that different stakeholders could easily coordinate.

Still, they faced a number of difficult questions about how to launch the initiative. One was how to persuade diverse stakeholders to share data on children, a subject that can prompt organizations to be guarded. To overcome this hesitation, the project’s leaders framed data sharing not in terms of ceding an asset or privileged information, but instead as a tactic to achieve a collective goal. As Glickman explained, they said, “‘Let’s not talk about data sharing. Let’s not talk about the analytics. Let’s talk about the results: here’s what it means for kids.’”

Another question was how to create an analytical tool that would enable them to leverage data and produce informative results efficiently. This was critical because other common interventions, such as randomized controlled trials (RCTs), often take years to complete, require a static environment, and sometimes end up having limited prescriptive value because the results are not replicable. In Roanoke, they instead chose to “do research on a dynamic basis,” which involved producing quick results and preserving the flexibility to explore multiple research questions. Specifically, the partners proposed an Early Childhood Analytics Model (ECAM) that would pool data from different stakeholders, would conduct rapid cycle evaluations (mini RCTs) to discern causal relationships, and should produce conclusions that can help guide program implementation and resource investment decisions. This tool allows them to “get the results back quickly to everybody and say, ‘Look, if you do this, your kid will do better.’”

The creation of the ECAM should provide a valuable clue for leaders hoping to scale the Human Services Value Curve: it is critical to establish buy-in around a shared goal and then create an easy-to-use tool that can help everyone achieve that aim.

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Taking the Project to Scale

While the planning for and design of the soon-to-launch ECAM had succeeded in Roanoke, the objective of Hazel, Glickman, and Ramey’s late-2015 conversation was to create a statewide ecosystem for collaboration, analysis, and reform. During his time in office, Hazel—in partnership with Glickman, Ramey, and others—has striven to create an environment that will help the commonwealth achieve what Hazel described as “collective impact.” This refers to a climate where there are not just “individual pockets of excellence” or “random acts of partnership;” instead, there is an ecosystem in which different stakeholders embrace “shared goals, strategies, and action plans.” Put differently, Hazel is trying to create an environment that will help the commonwealth ascend the Human Services Value Curve.

As Hazel also explained, achieving this objective will hinge primarily on the ability of different stakeholders to bridge the numerous vertical and horizontal silos that divide them. Hazel and his team have therefore endeavored to create an organizational structure and shared mission that can help bring historically divergent stakeholders together. This includes the Children’s Cabinet, a cross-secretariat, multi-agency collaborative created to better align policies and programs in support of [their] shared goal of serving Virginia’s youngest citizens.” According to Hazel, this group has served as the “backbone” for a more collaborative environment. In addition, in 2016, he and his colleagues complemented this structure with a shared vision, the Virginia Plan for Well-Being. This is a framework for physical and emotional wellness and aging well that focuses in part on early childhood development. In short, Hazel has tried to seed on a statewide basis the characteristics that will likely make Roanoke so successful.

Still, given the wide range of political beliefs across the commonwealth, Hazel has had to be careful to frame the state government’s work in an ideologically neutral fashion. This is in part a function of semantics. For example, he does not talk about “equity” and instead highlights “opportunity.” Hazel explained:

Equity is a really loaded term. If I talk about equity in Virginia, it’s not likely to get really far. But what we can talk about is opportunity … People buy the fact that in this country, you have an opportunity. And this [early childhood development] is where the opportunity starts. So, that’s why we’re focused here.

Hazel has not yet introduced a model like the ECAM at the state level; however, he and his partners have taken critical steps—namely creating a common organizational structure, establishing a shared mission, and building trust—that can set the stage for such a tool, and help the entire commonwealth progress along the Human Services Value Curve to create generative outcomes for children.

“I would submit to you that for most of the work we do with kids, the only thing ever measured besides a process is the cost. Where is the value?”
William Hazel
Secretary of Health and Human Resources, Commonwealth of Virginia

The Path Ahead

One year removed from their conversation in late 2015, Glickman, Hazel, and Ramey have done a great deal to help Virginia’s youth. In particular, they have built on the legacy of the Abecedarian Project and designed the ECAM in Roanoke, and they have continued a multi-year effort to create a collaborative statewide ecosystem. In the process, they have also sharpened their priorities. As Glickman said, “Having worked with Craig and Bill and others across the state, I am totally convinced that there is no better investment that we can make than in early childhood development for our children because that’s the way we’re going to solve these long-term problems.” In sum, the Commonwealth now has a prototype for a powerful analytical model, the foundations of a synergistic ecosystem, and a sharply defined strategic priority. That is a fantastic recipe for progressing along the Human Services Value Curve and improving the lives of Virginians for generations to come.

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